Forums » Open clinical » Diabetes » Severe hypoglycemia and death
|
Severe hypoglycemia and death
posted at 31/8/2012 7:51 PM BST
on bmj.com
|
Posts: 453
First: 29/4/2011 Last: 14/5/2013 |
Increased Mortality of Patients With Diabetes Reporting Severe HypoglycemiaAbstractOBJECTIVE Hypoglycemia is a cause of significant morbidity among patients with diabetes and may be associated with greater risk of death. We conducted a retrospective study to determine whether patient self-report of severe hypoglycemia is associated with increased mortality. RESEARCH DESIGN AND METHODS Adult patients (N = 1,020) seen in a specialty diabetes clinic between August 2005 and July 2006 were questioned about frequency of hypoglycemia during a preencounter interview; 7 were lost to follow-up and excluded from analysis. Mild hypoglycemia was defined as symptoms managed without assistance, and severe hypoglycemia was defined as symptoms requiring external assistance. Mortality data, demographics, clinical characteristics, and Charlson comorbidity index (CCI) were obtained from the electronic medical record after 5 years. Patients were stratified by self-report of hypoglycemia at baseline, demographics were compared using the two-sample t test, and risk of death was expressed as odds ratio (95% CI). Associations were controlled for age, sex, diabetes type and duration, CCI, HbA1c, and report of severe hypoglycemia. RESULTS In total, 1,013 patients with type 1 (21.3%) and type 2 (78.7%) diabetes were questioned about hypoglycemia. Among these, 625 (61.7%) reported any hypoglycemia, and 76 (7.5%) reported severe hypoglycemia. After 5 years, patients who reported severe hypoglycemia had 3.4-fold higher mortality (95% CI 1.5–7.4; P = 0.005) compared with those who reported mild/no hypoglycemia. CONCLUSIONS Self-report of severe hypoglycemia is associated with 3.4-fold increased risk of death. Patient-reported outcomes,
COMMENT: This retrospective study basically reinforces the ACCORD and VADT that suggest that in persons with pre-existing cardiovascular disease severe hypoglycemia is a risk factor. In a VADT sub-study those subjects with low calcium scores, suggesting minimal coronary arthrosclerosis, benefited from intensive therapy whereas those with high scores were put as risk by intensive therpy. |
|
|
Re: Severe hypoglycemia and death
posted at 31/8/2012 8:41 PM BST
on bmj.com
|
Posts: 3045
First: 27/3/2012 Last: 20/5/2013 |
A very important study. The most important & common cause of death in diabetic patients on hypoglycemic agents is hypoglycemia which is mostly due to a part of medical negligence. |
|
|
Re: Severe hypoglycemia and death
posted at 31/8/2012 9:39 PM BST
on bmj.com
|
Posts: 1785
First: 7/3/2009 Last: 22/5/2013 |
A family member of my good friends had diabetes. One night he went to sleep and never woke up. Hypoglycemia had killed him during night.The danger is real and a problem to be known about. We need a monitoring system that would at least warn about low blood glucose levels and even better would administer automatically a bolus of glucose and glucagon. Much like the ICD available for people with dangerous arrythmias.
|
|
|
Re: Severe hypoglycemia and death
posted at 11/9/2012 8:39 PM BST
on bmj.com
|
|
Posts: 3
First: 28/10/2011 Last: 14/5/2013 |
There are insulin pumps connected to continuous blood sugar monitors who can stop insulin delivery if the blood sugar level is too low, preventing severe hypoglycaemia from happening. But these systems are very pricey and very few people on insulin are ofered an insulin pump, even fewer with the loop system and continuous blood sugar monitoring system. A GP recently commented that a repeat prescription was very expensive (with common insulin vials and blood sugar strips). Diabetes is a costly disease in term of mortality and morbidity sadly.
|
|
|
Re: Severe hypoglycemia and death
posted at 11/9/2012 9:36 PM BST
on bmj.com
|
|
Posts: 20
First: 15/12/2009 Last: 21/5/2013 |
recommend all diabetics to have their BM checked at +/- 03:00 hours at intervals (alarm clock) - because the patient is asleep and how will anybody know what the levels are at that hour when one is supposed to be 'fast asleep' / in a near coma. |
|
|
Re: Severe hypoglycemia and death
posted at 15/9/2012 1:28 PM BST
on bmj.com
|
Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
At the present time, the more effective way of avoiding Hypoglycaemias is not targeting a normal or even close to normal HBA1C level in the vast majority of type 2 diabetics. Large Observational Sudies and All recent Randomised Clinical Trials targeting the so-called "Intensive Glycaemic control" have proved that. It seems that specially type 2 diabetics need a safer and higher HBA1C level for achieving longer and with better quality, lives. All the Best, Joey
|
|
|
Re: Severe hypoglycemia and death
posted at 16/9/2012 2:00 PM BST
on bmj.com
|
|
Posts: 1785
First: 7/3/2009 Last: 22/5/2013 |
Which brings me again to the problem with the increasing "numbers" theories being reverred as holy figures. I am not a typical epidemiologist and QA person, although these are among my main interests, but I find myself sort of a "white crow", because I believe in targeting the individual or at least a subpopulation rather than mass treatment.
|
|
|
Re: Severe hypoglycemia and death
posted at 16/9/2012 10:11 PM BST
on bmj.com
|
|
Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Hi Yoram: I indeed agree with you. What is so-called "Modern Medicine" or even "Evidence-Based Medicine", should be better called as REDUCTIONISTIC or DETERMINISTIC Medicine, because this fashion medical "science"is higly based on easy to achieve "Surrogates Markers of Disease instead of Hard Outcomes, is namely Drug Centred instead of appreciating the nuances of each individual and the Reality Truth that our treatments should be: Acccording to the Level of Individual Risk Instead of the Level of The Risk Factor: “In medicine, a risk factor is a trait that increases the likelihood of having something really bad happen to you. For example, having a high level of triglycerides is a risk factor for having a heart attack. (That means that having high triglycerides increases the likelihood you will suffer a heart attack.) But you want your doctor to try to prevent what’s really bad – the heart attack – not just treat your triglyceride level. Why? Because lowering your triglyceride level with some prescription drug won’t actually decrease your risk of a heart attack. Doctors need to treat what really matters to you, the patient, not what is merely measurable in you.” All the Best to You, Joey |
Forums » Open clinical » Diabetes » Severe hypoglycemia and death
